Abstract
BackgroundPatient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services.MethodsWe extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1).ResultsHIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6–4.9) per trip and had on average 6 visits (95% CI 5.9–6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).ConclusionDistance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.
Highlights
Patient choice and access to health care is compromised by many barriers including travel distance
Distance travelled and number of visits In a population of 3983 persons infected with human immunodeficiency virus (HIV) in north west England, the distances travelled to seek HIV care differed significantly according to socio-economic and demographic characteristics (Table 1)
Individuals visited an average of 6 times (95% confidence intervals 5.9–6.2) and travelled an average of 4.8 km (95%CI 4.6–4.9) to their clinic
Summary
Patient choice and access to health care is compromised by many barriers including travel distance. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services. Long distance travel is recognised to be an important factor limiting patient choice and access [4,5]. The Patient Choice Project was established to offer patients using the UK's National Health Service more choice over where and when they receive treatment, and to reduce waiting times [6]. Patient choice can override access barriers, and data from the USA revealed that more than half of patients surveyed in West Virginia bypassed local for more distant services [7]. Factors associated with bypass included age, income, and dissatisfaction with local services. Lack of specialty care, limited services, and the value of local services were most frequently mentioned
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